Silent myocardial ischemia

Encouraging gains have been made during the last decade toward the identification of silent myocardial ischemia as a clinical form of coronary heart disease and also as its earliest and most common manifestation. Many efforts have also been made in elucidating the incidence, pathogenesis, pathophysiology, as well as the specificity of laboratory tests and the relation to risk factors and to symptomatic ischemic episodes. Once thought to be an unusual phenomenon, largely confined to anecdotal reports, silent myocardial ischemia is now recognized to be a common occurrence in the middle-aged and elderly people. The first part of this selective review summarizes major findings and conclusions concerning: (a) the identification of silent myocardial ischemia as the earliest form of coronary heart disease; (b) the selection of patients; (c) the particular feature of silent myocardial ischemia pathogenesis.